Provider Demographics
NPI:1376991331
Name:PECKHAM, LERIN (RN)
Entity Type:Individual
Prefix:
First Name:LERIN
Middle Name:
Last Name:PECKHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1700
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-0856
Mailing Address - Country:US
Mailing Address - Phone:401-235-7469
Mailing Address - Fax:401-767-4516
Practice Address - Street 1:65 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4312
Practice Address - Country:US
Practice Address - Phone:401-235-7469
Practice Address - Fax:401-767-4516
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN51686163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse